Renal transplantation involves surgically implanting a kidney from a compatible donor into a recipient. It is indicated for patients with irreversible end-stage renal disease or who have had bilateral nephectomies or removal of their only functioning kidney. The transplant recipient undergoes careful evaluation and the donor kidney is surgically placed in the iliac fossa, connected to arteries and veins. The kidney may function immediately but hemodialysis is often needed until full function is achieved. Major complications include graft rejection as an immunological response against the foreign organ, as well as urinary tract, cardiovascular, and pulmonary issues. Nursing management involves pre- and post-operative care such as monitoring vitals and kidney function, managing diet

1. RENAL
TRANSPLANTATION
ALIYA RAHMAN

2. DEFINITION
❖ Renal transplantation is the surgical implantation of
human kidney from a compatible donor to a recipient

3. INDICATIONS
❖ Irreversible ESRD
❖ Bilateral nephrectomy
❖ Removal of solitary functioning kidney

4. CONTRAINDICATIONS
❖ Seropositivity to HIV
❖ Infection and malignancy - absolute contraindication
❖ Liver disease, Phycological disorders, CAD,
Hypertension, Respiratory disease, GI bleeding -
relative contraindication

5. TRANSPLANTATION CARE
❖ Selection of transplant recipient is based on careful
evaluation of client’s health status
❖ Bilateral nephrectomy performed prior to transplantation
❖ Kidney is surgically placed extra peritoneally in the iliac
fossa. Renal artery anastomosed to recipient’s
hypogastric internal or external iliac artery and renal vein
to recipient’s iliac vein. Usually kidney begin to function
immediately. Hemodialysis performed until good function
achieved

6. COMPLICATIONS
❖ Graft rejection
❖ Immunological reaction stimulated by HLA antigen against foreign donor kidney in an
attempt to get rid of it.
❖ Clinical features : fever, weight gain, anorexia, malaise, edema, anaemia, oliguria,
tenderness, at the site of transplanted kidney.
❖ Lab investigation - Leucocytosis increased blood urea, s.creatine, proteinuria,
decreased urine sodium excretion
❖ Radiological evidence - engraved kidney with poor flow of contrast due to edima
❖ Treatment
❖ Immunosuppression - steroid (Methyl prednisolone) or cytotoxic
drugs(cyclophosphamide, cyclosporine)
❖ Antilymphocyte globulin or anti lymphocyte serem - depress responds to specific
antigen

7. ❖ Urinary tract complications- UTI and deterioration of
renal function
❖ Cardiovascular complications- hypertension
❖ Pulmonary complications- pneumonia, pulmonary
edema , pulmonary emboli
❖ Musculoskeletal complications- osteoporosis
❖ Hydrocele and testicular atrophy
❖ Steroid induced cataract and glaucoma

8. NURSING MANAGMENT
❖ Pre operating nursing care
• Preparation of both the recipient and the donor as
for a major surgery
• Patient should not have infection
• Assess client’s understanding of procedure and
follow up regimen.

9. ❖ Post operative nursing care
• Monitor intake and output every 30 - 60 min and weigh the patient daily
• Monitor renal function, electrolyte balance, blood bio-chemistry, WBC and platelet
count
• Auscultate kidney regularly for bruits - stenosis at site of anastomosis
• Monitor vital signs
• Transplanted kidney may not function immediately and patient needs maintanance
dialysis. High urine output is desired
• Oliguria and anuria occur due to :-
• Obstruction of urine flow- check for catheter patency , if obstructed irrigate
gently using sterile technique
• Hypovolemia - IV fluid to increase urine output
• Coughing and de breathing exercise
• Sterile dressing of wound
• Good oral hygiene
• Dietary restriction, early ambulation and phycological support

10. THANK YOU